鞘内阿片类药物泵置入后成人脊柱畸形进展：4例报告
Progressive adult spinal deformity following placement of intrathecal opioid pump: a report of four cases.
作者信息
Daniel Jared W, Haft Geoffrey F
机构信息
Department of Orthopaedic Surgery University of Iowa Hospitals and Clinics, Iowa City, IA and Sanford Health/USD Medical Center, Sioux Falls, SD.
出版信息
Iowa Orthop J. 2014;34:144-9.
INTRODUCTION
Placement of intrathecal opioid pumps (ITOP) for chronic pain is a rare, but described cause of progressive spinal deformity. Over the last two decades there has been several suspected cases at our institution. In this case series, we described the apparent association between placement of an intrathecal opioid pump and progression of spinal deformity.
METHODS
The medical records of a single surgeon working at a single institution were retrospectively queried for patients seen between 1995-2010 to identify patients with spinal deformity and an ITOP. All hospital records including notes, radiographs, and labs were reviewed and analyzed. Spine radiographs were measured using standard techniques and reported as Cobb angles. This project was IRB approved and no external funding was used.
RESULTS
In total, we identified four patients with spinal deformity after placement of an ITOP. These patients were adults, two males and two females (ages: 48-80 years), with a unique medical history. Each participant's radiographs showed a progression of the spinal deformity following placement of ITOP. All patients underwent subsequent posterior spinal fusion for treatment of their progressive spinal deformities.
CONCLUSION
In this series, we have shown an apparent association between the placement of ITOP and progression of deformity in both patients with and without existing spinal deformity. While it is impossible to discern causality, all patients in our series had radiographic and clinical evidence of spinal deformity progression after placement of intrathecal pumps. These findings may raise awareness of this rare, but major, complication. In those performing pump placement, we recommend continued clinical and radiographic monitoring, through routine follow-up.
LEVEL OF EVIDENCE
Level 4--Case series; case control study (diagnostic studies); poor reference standard; analyses with no sensitivity analyses.
引言
植入鞘内阿片类药物泵（ITOP）用于治疗慢性疼痛是一种罕见但已被描述的导致脊柱畸形进展的原因。在过去二十年中，我们机构出现了几例疑似病例。在这个病例系列中，我们描述了鞘内阿片类药物泵的植入与脊柱畸形进展之间明显的关联。
方法
回顾性查询在单一机构工作的一位外科医生1995年至2010年间诊治的患者的病历，以确定患有脊柱畸形且植入了ITOP的患者。对所有医院记录，包括病历、X光片和实验室检查结果进行了审查和分析。使用标准技术测量脊柱X光片，并报告为Cobb角。本项目经机构审查委员会批准，未使用外部资金。
结果
我们总共确定了4例植入ITOP后出现脊柱畸形的患者。这些患者均为成年人，两男两女（年龄：48 - 80岁），有独特的病史。每位参与者的X光片显示，植入ITOP后脊柱畸形均有进展。所有患者随后均接受了后路脊柱融合术以治疗其进展性脊柱畸形。
结论
在本系列中，我们显示出在有或无现有脊柱畸形的患者中，ITOP的植入与畸形进展之间存在明显关联。虽然无法确定因果关系，但我们系列中的所有患者在植入鞘内泵后均有脊柱畸形进展的影像学和临床证据。这些发现可能会提高对这种罕见但严重并发症的认识。对于进行泵植入的人员，我们建议通过常规随访持续进行临床和影像学监测。
证据级别
4级——病例系列；病例对照研究（诊断性研究）；参考标准欠佳；未进行敏感性分析的分析。
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